Healthcare Provider Details

I. General information

NPI: 1336714773
Provider Name (Legal Business Name): HIRA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date: 03/29/2023
Reactivation Date: 07/08/2024

III. Provider practice location address

111 CLARA BARTON ST
DANSVILLE NY
14437-9503
US

IV. Provider business mailing address

111 CLARA BARTON ST
DANSVILLE NY
14437-9503
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-6001
  • Fax:
Mailing address:
  • Phone: 585-335-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number345105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: